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Originally developed and manufactured for the United States Army by American defense contractor West Tek, the T-45d power armor was the first version of power armor to be successfully deployed in battle.
In 2067, the first suit of T-45d power armor was deployed in Alaska during the start of the Anchorage Reclamation in the midst of the Sino-American War. This power armor was incredibly effective against Chinese tanks and infantry. Its ability to allow a single infantryman to carry heavy ordnance that otherwise required a team of soldiers to transport and operate became key in various localized conflicts on the Alaskan front, and it allowed American soldiers wearing the armor to destroy entire towns occupied by Chinese troops without endangering themselves. In 2076, the more advanced T-51b power armor variant was introduced into combat duty.

The T-45d lacks the mobility of later power armor models (such as the T-51b power armor) because of its less advanced servo design; as a result it limits the wearer's Agility. The first version of T-45d power armor deployed on the front lines against the Chinese was powered by small energy cells and it burned through them at an alarming rate.

While the T-45d armor is similar in its overall shape to the newer T-51b power armor, it is significantly less advanced than its later counterpart, and uses riveted steel plates instead of plastic composite materials in its construction. Various electronic and mechanical subsystems of the armor are exposed on the outside of its casing rather than sealed within as in the T-51b, making it far more susceptible to damage. In addition, a specialized body suit is required to be worn underneath the T-45d's armored shell in order to facilitate linking the armor's servos to the wearer's own motions and to make the armor more bearable because of its heat dissipation problems.

T-45d suits were used by the Brotherhood of Steel, especially used by Brotherhood Knights and Paladins, along with modifications and makeshift repairs. Other variations can be found in terms of coloring and other decorations.

The MP-47/A prototype medic power armor is a U.S. Army variant of T-45d power armor. It was designed to administer medical attention to the user as necessary during combat.

The prototype medic power armor has the ability to administer Med-X, which it will do if the wearer's health drops below 33%, if a limb's health drops below 25%, or if both of these conditions are met Med-X will be dispensed every 2.5 hours. Unlike standard Med-X injections, this process carries no risk of addiction. However, it does draw from the wearer's supply of Med-X, and thus the feature is useless if the player has none.

As noted in the accompanying manual, the prototype version of the suit lacks the ability to dispense anything other than Med-X, whereas the completed version would have had a wider range of features, such as deploying stimpaks. The armor was planned as an automatic medical supply dispenser, meaning troops would not have to be evacuated for medical treatment. The user manual found with the armor details that the final version was to also include a lethal chemical that would trigger if the soldier deserted.

T-45d armor was also to appear in Van Buren, Black Isles canceled Fallout 3 Project. Corporal Armstrong wears this armor, but indicates that it is powered by small energy cells, and consumes these at a high rate[1]

According to the Courier's dialogue with Ricky, T series power armors' eye-slits are bulletproof.